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LBH 2022 > Misc > Flashcards

Misc Flashcards

1
Q

Drugs that cause AIN?

A 
NSAIDs, including COX-2 inhib
Penicillins and cephalosporins
Rifampicin
Bactrim
Ciprofloxacin
Cimetidine (H2 blocker)
Allopurinol
PPIs (Omeprazole, lansoprazole)
Indinavir
5-ASAs (eg. Mesalamine)
Anti-cancer drugs, including immune checkpoint inhibitors (Ipilimumab, Nivolumab)
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2
Q

Drug induced thrombotic microangiopathy (DITMA) via immune-mediated mechanism

A

Quinine - the most common cause of immune-mediated DITMA

ABx: Bactrim, also cipro, metronidazole, mefloquine

Gemcitabine
Oxaliplatin
Quetiapine
Adalimumab

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3
Q

Drug induced thrombotic microangiopathy via non-immune mechanism

A

Cancer therapies: dose-dependent toxicity

Proteasome inhibitors: Bortezomib, carfilzomib, ixazomib

VEGF inhibitors (well described): Bevacizumab, sunitinib

Haematopoietic cell transplantation

ISx agents: CNI - cyclosporine, tacrolimus, sirolimus

Oxycodone, ecstasy, cocaine

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4
Q

Function of Vit A

A

Protein synthesis and cell differentiation
Vision
Epithelial tissues and skin health
Supports reproduction and growth

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5
Q

Vit A deficiency

A 
Impaired night vision
Xeropthalmia
Loss of skin integrity
Decreased immune function 
Painful joints

RF for deficiency:

  • Liver disease
  • CF (fat malabsorption)
  • Anorexia nervosa
  • Very low fat diets

Common in developing countries.

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6
Q

Vit D

A

Bone health

Maintinas Ca and Po4 homeostasis

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7
Q

Vit D deficiency

A

Osteomalacia (adults)
Rickets (children)
Impaired modulation of immune and neuromuscular systems

RF for deficiency:

  • Dark skin, no sun exposure
  • Elderly
  • Inadequate calcium intake
  • Liver disease
  • Untreated coeliac, renal disease and other malabsoprtion conditions
  • Corticosteroid use
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8
Q

Vit E

A

Antioxidant in cell membranes

Protects against fatty acid peroxidation

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9
Q

Vit E deficiency

A

Haemolytic anaemia
Central or peripheral neuropathy, myopathy
Increased atherosclerosis

RF for deficiency:

  • CF/fat malabsorption syndromes
  • Premature babies
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10
Q

Vit K

A

Blood coagulation
Activates several clotting factors, including prothrombin
Bone calcification

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11
Q

Vit K deficiency

A

Bleeding disorders
May cause decreased bone density

RF for deficiency:
CF and other fat malabsorption syndromes
Prolonged abx use

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12
Q

Wernick encephalopathy

A

Ophthalmoplegia
Ataxia
Confusion

Due to thiamine (vit B1) deficiency

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13
Q

Thiamine (B1)

A

Metabolism of carbohydrates

Fat and branched-chain amino acids

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14
Q

Vitamin b1 deficiency

A 
Severe lactic acidosis
Beriberi with neurological and cardiac effects
Wernicke-Korsakoff syndrome
Peripheral neuropathy
Decreased immune function
RF for deficiency:
EtOH
Liver disease
Malnutrition
Bariatric surgery
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15
Q

Pyridoxine (Vit B6)

A

Synthesis of lipids, neurotransmitters, steroid hormones and haemoglobin

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16
Q

Pyridoxine (Vit B6) deficiency

A

Anaemic
Peripheral neuropathy
Rash
Depression

RF for Vit B6 deficiency:
Older age
Malnutrition

17
Q

Vit B12

A

DNA synthesis

Closely linked with folate; each depends on the other for activation

18
Q

Vit B12 deficiency

A

Demyelination of neurones -> leading to peripheral neuropathy, spinal cord damage, optic atrophy and dementia

Impaired RBC function; megaloblastic anaemia

RF for deficiency:

  • Autoimmune gastritis (pernicious anaemia)
  • Gastrectomy
  • Significant small bowel resection, particularly terminal ileal resection
  • Bariatric surgery
  • Vegan diet

Treatment:
- Hydroxycobalamin 1 mg IM on alternate days for 2 weeks.

19
Q

Ascorbic acid (vitamin C)

A

Collagen synthesis
Immune defence
Antioxidant
Absorption of iron

20
Q

Vit C (ascorbic acid) deficiency

A 
Follicular hyperkeratosis
Impaired wound healing
Impaired immune function
Bleeding gums
Anaemia
Muscle degeneration
Scurvy
21
Q

Zinc

A

Cofactor for > 100 enzymes

Stabilises cell membranes and defends against free radicals

22
Q

Zinc deficiency

A 
Decreased immune function
Impaired wound healing
Hair loss
Impaired taste and appetite
Low insulin levels
Eczematous skin rash
Decreased spermatogenesis
Delayed onset of puberty
23
Q

Amantadine

A

NMDA receptor antagonist

24
Q

Dopamine agonist

A

Apomorphine
Pramipexole
Ropinirole
Rotigotine

Mode of action
Stimulate dopamine receptors; inhibit prolactin secretion; reduce size of prolactinomas; decrease growth hormone concentration in people with acromegaly.

SE:
Gambling, punding, addiction

25
Q

Indications for valve replacement – AR

A

Severe AR with symptoms
Severe AR with resting LVEF <50% even if asymptomatic
Severe AR undergoing CABG or surgery of ascending aorta/another valve

26
Q

Indications for valve replacement – AS

A

Severe AS with gradient >/= 40 mmHg or peak velocity >4.0 m/s + symptoms

Low flow/low gradient AS (excluding pseudosevere AS) + symptoms

Severe AS undergoing CABG/surgery of ascending aorta or of another valve

27
Q

Valve replacement – Aortic root dilation

A

Marfan syndrome with aortic root disease + ascending aortic diameter >/= 50 mm

> /= 45 mm with Marfan + other risk factors

> /=50 mm with bicuspid valve/coarc/other risk factors

> /=55 mm for anyone

28
Q

Indications for valve replacement –

Mitral regurgitation

A

Primary MR
Severe MR with symptoms and LVEF >30%
Severe MR, asymptomatic but with LV impairment (LVESD >45 mm or LVEF > 60%)
Consider in asymptomatic with preserved function

Secondary MR
Severe secondary MR undergoing CABG and LVEF >30%
Symptomatic patients with severe secondary MR, LVEF <30% with an option for revascularisation and evidence of myocardial viability.

29
Q

Mitral stenosis – Indications for valve replacement

A

Symptomatic patients without unfavourable characteristics

LBH 2022 (10 decks)

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